Sex-Specific Factors Affecting Quality of Life After Major Trauma: Results of a Prospective Multicenter Registry-Based Cohort Study

Overview

Journal Healthcare (Basel)

Specialty Health Services

Date 2025 Feb 25

PMID 39997312

Authors

Viola Freigang

Karolina Muller

Antonio Ernstberger

Volker Alt

Anne Herrmann-Johns

Florian Baumann

Affiliations

Soon will be listed here.

Abstract

: Major trauma is a leading cause of severe disability and mortality. The influence of patient sex on outcome after severe trauma is a topic of ongoing discussion. We present a prospective multicenter study on the effects of trauma severity on health-related quality of life (HRQoL) of female patients. We hypothesized that the impairment of HRQoL after major trauma between the sexes depends not only on sex itself but also on age. : This multicenter prospective registry-based observational study compared sex-based differences in HRQoL of patients who sustained major trauma Injury Severity Score (ISS ≥ 16). The HRQoL was assessed using the EQ-5D-3L (European Quality of Life 5-Dimension 3-Level Version) score over 2 years post-trauma. : We included 416 patients (116 female/300 male) with an ISS > 16 (median ISS 22 IQR 18/30). All patients had a lower HRQoL after trauma than the population norm. Increased AIS (Abbreviated Injury Scale) face and extremity scores and ASA (American Society of Anesthesiologists) scores showed a significant decrease in HRQoL. Even though the groups of female and male patients were comparable in injury severity, female patients reported significantly more problems on the anxiety and depression scales than male patients 6 months ( = 0.003) and 24 months ( = 0.044) after trauma (6 months: female 46% vs. male 30%; 24 months: female 44% vs. male 32%). We observed the greatest improvement in the EQ Index over time in patients between 16 and 39 years of age, especially female patients (0.78 to 0.87 in females under 39 years of age, compared to males in the same age group 0.76 to 0.81). Females over 65 years of age initially presented the lowest EQ Index of 0.62. It remained significantly lower over time and was lower compared to male patients of the same age group (female EQ Index after 24 months was 0.68 compared to men over the age of 65 who presented an EQ Index of 0.75). : All patients included in this study presented a lower HRQoL after trauma than the population norm. Female patients under 39 years of age reported the most improvement. Females over 65 years of age showed a limited HRQoL, which remained significantly lower over time. Female patients reported significantly more anxiety and depression after major trauma than male patients. Thus, further development and methodologically rigorous testing of ortho-geriatric initiatives, psychosocial support, and prevention measures are required to improve the care after major trauma, particularly for the female elderly.

References

Wad M, Laursen T, Fruergaard S, Morgen S, Dahl B . Survival and health related quality of life after severe trauma - a 15 years follow up study. Injury. 2017; 49(2):191-194. DOI: 10.1016/j.injury.2017.10.001. View

Gannon C, Napolitano L, Pasquale M, Tracy J, McCarter R . A statewide population-based study of gender differences in trauma: validation of a prior single-institution study. J Am Coll Surg. 2002; 195(1):11-8. DOI: 10.1016/s1072-7515(02)01187-0. View

Mackenzie E, Damiano A, Miller T, Luchter S . The development of the Functional Capacity Index. J Trauma. 1996; 41(5):799-807. DOI: 10.1097/00005373-199611000-00006. View

Baker S, ONeill B, HADDON Jr W, Long W . The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974; 14(3):187-96. View

Beijer E, van Wonderen S, Zuidema W, Visser M, Edwards M, Verhofstad M . Sex Differences in Outcome of Trauma Patients Presented with Severe Traumatic Brain Injury: A Multicenter Cohort Study. J Clin Med. 2023; 12(21). PMC: 10649467. DOI: 10.3390/jcm12216892. View

George R, McGwin Jr G, Metzger J, Chaudry I, Rue 3rd L . The association between gender and mortality among trauma patients as modified by age. J Trauma. 2003; 54(3):464-71. DOI: 10.1097/01.TA.0000051939.95039.E6. View

Hannan E, MENDELOFF J, Farrell L, Cayten C, Murphy J . Multivariate models for predicting survival of patients with trauma from low falls: the impact of gender and pre-existing conditions. J Trauma. 1995; 38(5):697-704. DOI: 10.1097/00005373-199505000-00004. View

Cook E, Laycock J, Sivapathasuntharam D, Maturana C, Hilton C, Doherty L . Surgical versus non-surgical management of lateral compression type-1 pelvic fracture in adults 60 years and older: the L1FE RCT. Health Technol Assess. 2024; 28(15):1-67. PMC: 11017634. DOI: 10.3310/LAPW3412. View

Joestl J, Lang N, Kleiner A, Platzer P, Aldrian S . The Importance of Sex Differences on Outcome after Major Trauma: Clinical Outcome in Women Versus Men. J Clin Med. 2019; 8(8). PMC: 6722913. DOI: 10.3390/jcm8081263. View

10.

McCrum M, Leroux B, Fang T, Bulger E, Arbabi S, Wade C . Sex-based differences in transfusion need after severe injury: Findings of the PROPPR study. Surgery. 2019; 165(6):1122-1127. PMC: 6581613. DOI: 10.1016/j.surg.2018.12.023. View

11.

Koller M, Ernstberger A, Zeman F, Loss J, Nerlich M . Outcome after polytrauma in a certified trauma network: comparing standard vs. maximum care facilities concept of the study and study protocol (POLYQUALY). BMC Health Serv Res. 2016; 16:242. PMC: 4940898. DOI: 10.1186/s12913-016-1468-5. View

12.

Irish L, Fischer B, Fallon W, Spoonster E, Sledjeski E, Delahanty D . Gender differences in PTSD symptoms: an exploration of peritraumatic mechanisms. J Anxiety Disord. 2010; 25(2):209-16. PMC: 3031659. DOI: 10.1016/j.janxdis.2010.09.004. View

13.

Abate K . Gender disparity in prevalence of depression among patient population: a systematic review. Ethiop J Health Sci. 2013; 23(3):283-8. PMC: 3847538. DOI: 10.4314/ejhs.v23i3.11. View

14.

Zarzaur B, Holler E, Ortiz D, Perkins A, Lasiter S, Gao S . Collaborative Care for Injured Older Adults: The Trauma Medical Home Randomized Clinical Trial. JAMA Surg. 2024; 159(7):756-764. PMC: 11079789. DOI: 10.1001/jamasurg.2024.1043. View

15.

Angele M, Frantz M, Chaudry I . Gender and sex hormones influence the response to trauma and sepsis: potential therapeutic approaches. Clinics (Sao Paulo). 2006; 61(5):479-88. DOI: 10.1590/s1807-59322006000500017. View

16.

Innocenti F, Coppa A, Del Taglia B, Trausi F, Conti A, Zanobetti M . Prognosis and health-related quality of life in elderly patients after a mild to moderate trauma. Intern Emerg Med. 2014; 9(4):467-74. DOI: 10.1007/s11739-013-1039-2. View

17.

Visser E, Den Oudsten B, Traa M, Gosens T, de Vries J . Patients' experiences and wellbeing after injury: A focus group study. PLoS One. 2021; 16(1):e0245198. PMC: 7790403. DOI: 10.1371/journal.pone.0245198. View

18.

Probst C, Pape H, Hildebrand F, Regel G, Mahlke L, Giannoudis P . 30 years of polytrauma care: An analysis of the change in strategies and results of 4849 cases treated at a single institution. Injury. 2009; 40(1):77-83. DOI: 10.1016/j.injury.2008.10.004. View

19.

Pape M, Giannakopoulos G, Zuidema W, de Lange-Klerk E, Toor E, Edwards M . Is there an association between female gender and outcome in severe trauma? A multi-center analysis in the Netherlands. Scand J Trauma Resusc Emerg Med. 2019; 27(1):16. PMC: 6373135. DOI: 10.1186/s13049-019-0589-3. View

20.

Scheetz L, Orazem J . The influence of sociodemographic factors on trauma center transport for severely injured older adults. Health Serv Res. 2020; 55(3):411-418. PMC: 7240777. DOI: 10.1111/1475-6773.13270. View